الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Tricuspid regurgitation (TR) is either primary or secondary (functional). Primary TR is due to organic valve lesion like congenital anomalies and bacterial endocarditis [1].Functional tricuspid regurgitation (FTR) is mostly secondary to left sided heart valvular lesion mostly mitral valve disease (MVD). When high pulmonary pressure develops, it can attribute to right ventricle and annular dilatation and, eventually, to tricuspid valve (TV) tenting. The tricuspid leaflets are morphologically normal but do not coapt adequately. However, not all patients with pulmonary hypertension develop TR, the cause for which seems to be multifactorial and related to other factors such as atrial fibrillation (AF) and right heart enlargement. The most common causes of secondary FTR are Left sided heart disease (significant aortic or mitral valve disorder, or left ventricular dysfunction, chronic pulmonary disease and primary pulmonary hypertension.
FTR is commonly associated with MVD, and the presence of significant TR is reported to be an alarming sign of poor prognosis after the surgical intervention of MVD. FTR may decrease or totally corrected after resolution of the left heart lesion responsible for the overloading of the right ventricle. However, TR progression occurs in as many as one half of patients. Moderate TR is associated with poor long-term survival, because of the difficulties in predicting the patients in whom moderate regurgitation will resolve or progress after mitral valve (MV) surgery. Concomitant TV repair at the time of MV surgery has been recommended in patients with severe functional TR to improve long-term clinical outcomes. However, the decision to repair moderate FTR during MV surgery remains controversial . Our study focused on intervention by
tricuspid ring annuloplasty for moderate TR during MV surgery.
All patients had concomitant moderate TR and were listed for
mitral valve surgery. They were classified into group A, tricuspid valve
ring annuloplasty (TVA) group, including 34 patients who underwent
MV surgery and TV repair and group B, tricuspid non repair (TVN)
group, 46 patients who underwent MV surgery alone.
Exclusion criteria were TR with definite organic leaflet or
subvalvular deformities, such as prolapse, Ebstein anomaly, rheumatic,
infective endocarditis and patients who have concomitant surgical
procedures other than mitral and tricuspid.
Patient’s medical history including age, sex, New York Heart
Association (NYHA) classification, preoperative risk factors were
recorded. Echocardiography was done for all patients and assessment was
done for all patients before surgery and one and 6 months after. Our
echocardiographic study was to assess tricuspid regurgitation using the
apical four-chamber view and graded as mild, moderate, or severe when
the distal jet area was less than 5cm, 5-10 cm or greater than 10 cm,
respectively, in addition to assessment of ejection fraction (EF), diameter
of left ventricle and pulmonary artery pressure (PAP).
in pre-operative data, In group A, age ranged from 35-81 years
with a mean of age was 64.2±13.2 years. There were 34 patients, 15
males (44.9%) and 19 females (55.1%). While in group B, age ranged
from 18-84 years with a mean of age was 61.6±13.5 years. There were 14
male (30.4%) and 32 females (69.6%).
NYHA classification. In group A, 14 cases (41.2%) had NYHA
class 3 and 20 cases (58.8%) had NYHA class 4. While in group B, 21
cases (45.7%) had NYHA valve pathology. In group A, 27 cases had
mitral valve regurgitation (97.4%), 2 cases had mitral valve stenosis (8.8%) and 4 cases had mixed lesion (11.8%). While in group B, 35cases (76.1%) had mitral valve regurgitation, 4 cases had mitral valve stenosis (8.7%) and 7 cases (15.2) had mixed lesion. class 3 and 25 cases (54.3%) had NYHA class 4.
Valve procedure. In group A, 11 cases (32.4%) had mitral valve replacement and 23 cases (67.6%) had valve repair. While in group B,21 cases (45.7%) had valve replacement and 25 cases (54.3%) had mitral valve repair.
ICU stay, in group A Mean±SD was 3.9±1.5 days. While in group B, Mean±SD was 4.5±1.4. Duration of post-operative stay. In was group one was Mean±SD 11.2 ±4.1 days. While in group B, Mean±SD was 12.7±4.6 days and the range was 6-23. Post-operative complication in group A, 20 cases (58.8%) develop post-operative complication and 14 cases didn’t develop any complication while in group B, 25 cases (54.3%) developed post-operative complication and 21 cases (45.7%) didn’t.
In group A, LVES Mean±SD was 33.8±7.4 mm. While in group B, LVES Mean±SD was 32.7±9.5mm. LVED in group A, Mean±SD was 49.2±10.6mm. While in group B, LVED Mean±SD was 46.8±9.5mm. Regarding to EF in group A, Mean±SD was 58.8±8.4. While in group B, Mean±SD was 59.5±8.8.
After one month follow up, presence of TR in group A, no TR were detected in 24 cases (70.6%), mild TR in 9cases (26.5%), no cases with moderate TR and 1 case (2.9%) develop sever TR. While in group B, no TR was detected in 12 cases (26.1%), mild TR in 27cases (58.7%), moderate TR were detected in 6 cases (13%) and sever TR was detected in 1 case (2.9%). PAP in group A, Mean±SD was 27.2±5.1mmHg. While in group B, PAP Mean±SD was 31.7±6.8 mmHg. LA diameter in group A, Mean±SD was 48.7±8.9mm. While in group B, Mean±SD was 47.6±8.5. RV size in group A, Mean±SD was 25.0±5.5 mm3. While in group 2, Mean± SD was 23.9±3.9. TAPSE in group A, Mean±SD was 12.5±4.0 mm. While in group B, Mean±SD was 12.2±3.4mm. RA size in group A, 39 cases (82.4%) were normal size, and 6 cases(17.6%) were dilated, while in group 2,39 cases (67.4%) were normal and 7 cases (15.2%)were dilated.
After six months follow up in group A, LVES Mean±SD 33.2±7.9mm. While in group B, LVES Mean±SD was 32.0±6.9mm. LVED in group A Mean±SD was 48.7±9.2mm. While in group B, Mean±SD was 46.0±9.2mm. EF in group A, Mean±SD was 58.8±8.4. While in group B, Mean±SD was 59.8±8.3mmHg. There was no statistical difference between the two groups. Presence of TR in group A, no TR were detected in 22 cases (70.6%), mild TR in 11cases (26.5%),no cases with moderate TR and 1 case (2.9%) develop sever TR. While in group B, no TR was detected in 15 cases(32.6%),mild TR in 23cases (50%), moderate TR were detected in 7 cases(15.2%) and sever TR was detected in 1 case (2.2%). PAP in group A, Mean±SD was 27.2±5.1 mmHg. While in group 2 PAP Mean±SD was 31.7±6.8 mmHg. LA diameter in group A, Mean±SD was 48.2±8.8 mm. While in group B, Mean±SD was 47.5±8.1 mm. There no was statistical difference between the two groups. Also high PAP and dilated RV were detected as a predictors of persistence or progression of TR.